Sponsors asked the IOM's Food and Nutrition Board and the Division of Behavioral and Social Sciences and Education Board on Children, Youth, and Families to review and update the IOM (1990) recommendations for weight gain during pregnancy and recommend ways to encourage their adoption through consumer education, strategies to assist practitioners, and public health strategies.The committee was asked to address the following tasks: 1. Review evidence on the relationship between weight gain patterns before, during, and after pregnancy and maternal and child health outcomes, with particular attention to the prevalence of maternal obesity racial/ethnic and age differences, components of GWG, and implications of weight during pregnancy on postpartum weight retention, maternal and child obesity, and later child health. 2. Within a life-stage framework consider factors in relation to GWG that are associated with maternal health outcomes such as lactation performance, postpartum weight retention, cardiovascular disease, metabolic processes including glucose and insulin-related issues, and risk of other chronic diseases; for infants and children, in addition to low birth weight, consider early developmental impacts and obesity-related consequences (e.g., mental health, diabetes). 3. Recommend revisions to the existing guidelines, where necessary, including the need for specific pregnancy weight guidelines for underweight, normal weight, and overweight and obese women and adolescents and women carrying twins or higher-order multiples. 4. Consider a range of approaches to promote appropriate weight gain, including: individual (behavior), psychosocial, community, health care, and health systems; timing and components of interventions; and ways to enhance awareness and adoption of the guidelines, including interdisciplinary approaches, consumer education to men and women, strategies to assist practitioners to use the guidelines, and public health strategies. 5. Identify gaps in knowledge and recommend research priorities.

/pdf/weight-gain-during-pregnancy-reexamining-the-guidelines-54naat6auf.pdf

Weight Gain During Pregnancy: Reexamining the Guidelines

The Maturational Processes and the Facilitating Environment

http://www.pediatrasandalucia.org/Pdfs/Childhood_Functional_Gastrointestinal_Disorders_NeonateToddler.pdf

Childhood Functional Gastrointestinal Disorders: Neonate/Toddler

Objective To conduct a systematic review of the literature on risk factors for dental caries in deciduous teeth of children aged six years and under, to give a scientific framework for the international collaborative studies on inequalities in childhood caries. Method Accepted guidelines were followed. Studies were identified by electronic searching and reviewed on the basis of key words, title and abstract by two reviewers to assess whether inclusion criteria were met. Copies of all articles were obtained and assessed for quality according to the study design. Results 1029 papers were identified from the electronic search, 260 met the prima facie inclusion criteria. 183 were excluded once full copies of these papers were obtained. Of the 77 studies included, 43 were cross sectional, 19 cohort studies, 8 case control studies and 7 interventional studies. Few obtained the highest quality scores. 106 risk factors were significantly related to the prevalence or incidence of caries. Conclusion There is a shortage of high quality studies using the optimum study design, i.e. a longitudinal study. The evidence suggests that children are most likely to develop caries if Streptococcus Mutans is acquired at an early age, although this may be partly compensated by other factors such as good oral hygiene and a non- cariogenic diet. Diet and oral hygiene may interact so that if there is a balance of ‘good’ habits by way of maintaining good plaque control and ‘bad’ habits by way of having a cariogenic diet, the development of caries may be controlled.

https://www.who.int/oral_health/media/en/orh_cdh_0304_05_risk_factors.pdf

Risk factors for dental caries in young children: a systematic review of the literature.

Lactobacillus rhamnosus GG, ATCC (LGG), has shown antagonism to many bacteria including mutans streptococci. This randomized, double–blind, placebo–controlled intervention study was

Effect of Long–Term Consumption of a Probiotic Bacterium, Lactobacillus rhamnosus GG, in Milk on Dental Caries and Caries Risk in Children

It is generally understood that the teeth of pre-school-aged children are healthy, but the improvement in the dmft index has halted in the industrialized countries. Those few children who have caries have more of it than before. Little is known of the family-related factors which are associated with this polarization of caries. A representative population-based sample consisted of 1443 mothers expecting their first child. The children were followed at well-baby clinics and public dental health clinics for over five years. The objective was to study the prevalence of dental caries and its predictors in five-year-old children and to assess children's own dental health habits and the meaning of family-related factors in dental health. The findings were based on questionnaire data from parents and on clinical dental examinations of the five-year-old children as completed by 101 public health dentists. In firstborn five-year-old children, dental health was found to be good in 72%, fair in 20%, and poor in 8% of the cases. The final multivariate analysis illustrated that the dmft index > 0 was independently associated with the mother's irregular toothbrushing (OR 2.2; 95% CI 1.4-3.5), annual occurrence of several carious teeth in the father (OR 2.6; 95% CI 1.9-3.6), daily sugar consumption at the age of 18 months (OR 2.4; 95% CI 1.4-4.1), occurrence of child's headaches (OR 3.7; 95% CI 1.5-8.8), parents' cohabitation (OR 3.3; 95% CI 1.5-7.6), rural domicile (OR 2.4; 95% CI 1.2-4.5), and mother's young age (OR 5.0; 95% CI 1.3-19.8). The findings indicated that attention should be paid not only to the child's dental health care but also to that of the whole family. Parents should be supported in their upbringing efforts and encouraged to improve their children's dental health habits. In everyday life, parents function as role models for their children, and therefore, parents' own dental hygiene habits are very meaningful.

Caries in Five-year-old Children and Associations with Family-related Factors

OBJECTIVE--To study associations between characteristics of families during the first pregnancy and after childbirth and the development of infantile colic. DESIGN--Randomised, stratified cluster sampling. Follow up from the first visit to a maternity health care clinic during pregnancy to three months after birth with confidential semistructured questionnaires. SETTING--Maternity health care clinics in primary health care centres in Finland. SUBJECTS--1443 nulliparous women and 1407 partners. Altogether 1333 women and 1279 men returned the questionnaires. When the infants were 3 months old 1208 women and 1115 men returned questionnaires. MAIN OUTCOME MEASURES--Marital relationship; personal and social behaviour of parents during the pregnancy and their coping with the pregnancy; mothers9 physical health and events, symptoms, and experiences in relation to pregnancy; self confidence and experiences of mothers and fathers in relation to childbirth; and parents9 sociodemographic and educational variables. Measure of colic when the infant was 3 months old. RESULTS--Experience of stress and physical symptoms during the pregnancy, dissatisfaction with the sexual relationship, and negative experiences during childbirth were associated with the development of colic in the baby. None of the sociodemographic factors was associated with colic. CONCLUSIONS--Early preventive health work during pregnancy should attempt to improve parents9 tolerance of symptoms of stress and ability to cope and increase their confidence in parenting abilities.

https://www.bmj.com/content/bmj/307/6904/600.full.pdf

Psychosocial predisposing factors for infantile colic.

Objective Our objective was to study the prevalence of different headache types, characterizations, and triggers of headache in Finnish children starting school. Methods Questionnaires were sent to 1,132 families with 6-year-old children. Children with headache disturbing their daily activities (n = 96) and an asymptomatic control group of children (n = 96) participated in a clinical interview and examination. Results Children with headache had significantly more bruxism (odds ratio [OR], 1.9; 95% CI, 1.0 to 3.4), tenderness in the occipital muscle insertion areas (OR, 4.8; 95% CI, 1.8 to 12.7), and tenderness in the temporomandibular joint areas (OR, 2.8; 95% CI, 1.3 to 6.0). They also had more travel sickness (OR, 3.4; 95% CI, 1.7 to 6.7) than control children. Eating ice cream (OR, 5.3; 95% CI, 1.4 to 20.31, fear (OR, 3.7; 95% CI, 1.2 to 11.21, and anxiety (OR, 3.2; 95% GI, 1.0 to 10.8) triggered headache more often in migraineurs than in children with tension-type headache. Children with migraine also reported more frequently abdominal (OR, 5.6; 95% CI, 1.7 to 18.1) and other (OR, 3.5; 95% CI, 1.2 to 9.8) pain concurrently with headache, and they used medication for pain relief more often (OR, 3.1; 95% CI, 1.0 to 9.5). Conclusions Headache classification in children may be improved by palpation of occipital muscle insertions and temporomandibular joint areas, and by discerning a history of triggering events and concurrent symptoms.

Childhood headache at school entry A controlled clinical study

Objective. This study reports the pain sensitivity of children with headache and their family members, as well as the prevalence of recurring aches, psychosocial life, and family environment of children with headache at preschool age. Design. A representative population-based sample of 1443 families expecting their first child were followed over 7 years. A screening questionnaire relating to the child9s headache was sent to parents of a representative sample of 1132 6-year-old children. Of 144 children suffering from headache, 106 (76%) were examined and interviewed clinically. Ninety-six children with primary headache (58 migraine and 38 tension-type headache children) and matched controls (n = 96) were included in further examinations. Results. Children with headache were more often extremely sensitive to pain according to their parents, were more excited about physical examinations, cried more often during blood sampling or vaccination, avoided play or games more often because they were afraid of hurting themselves, and had recurring abdominal and growing pains more often than did control children. The fathers of children with headache were more often extremely sensitive to pain. Children with headache reacted with somatic symptoms, usually with pain and functional intestinal disorders in stress situations, felt more tired, and had more ideations of death during the previous month. They had also had more problems in day care and fewer hobbies such as scout or club meetings than did control children. More mothers of tension-type headache children than those of migraine children reported that they were considerably sensitive to pain. Tension-type headache children also had a poorer family environment; the family atmosphere was more often unhappy and the relationship between the parents was more often distant than in the families of children with migraines. Conclusions. In addition to somatic factors, it is important to consider the child9s pain sensitivity, reaction to various stress situations, and family functioning when studying childhood headache. The child9s coping mechanisms can be supported by information given by the parents. School entry can be considered a suitable period for careful investigation into possible occurrence of headache and also for giving information about headache and its management.

Pain experience of children with headache and their families: A controlled study.

Objectives To provide current information on the academic achievement of small-for-gestational-age (SGA) children at age 10 years, to analyze predictors, and to evaluate the smallness of a newborn as a risk factor for school failure. Design Prospective, population-based birth cohort study with 10-year follow-up. Participants The SGA group consisted of 106 children born in 1985 whose birth weight had been below the 2.5th percentile on the population-based fetal growth chart. The control group consisted of 105 appropriate-for-gestational-age (AGA) children born as closely as possible in time to SGA infants and matched for gestational age and mode of delivery. Both groups were evaluated at age 10 years. Main Outcome Measure Academic achievement. Results Twenty-five percent of SGA children were school failures (vs 14% of AGA children; P = .05). There were significantly more SGA than AGA children with unfavorable backgrounds and deficient performances associated with poor academic achievement. Independent predictors of poor academic achievement in SGA and AGA children were inattention-passiveness as rated by their teachers (masked to grouping; corresponding to a 1-point increase in inattention-passiveness score: odds ratio, 5.1; 95% confidence interval, 2.1-12.1), a low verbal IQ score (psychologists masked; corresponding to a 10-point decrease in IQ score: odds ratio, 3.2; 95% confidence interval, 1.6-6.2), and restlessness at the follow-up visit (one examiner masked and the other not; odds ratio, 14.3; 95% confidence interval, 2.1-97.3). Conclusion Being SGA at birth has a clinically significant impact on the academic achievement of a 10-year-old child.

https://jamanetwork.com/journals/jamapediatrics/articlepdf/191513/poa10176.pdf

Päivi Rautava

Papers

Caries in Five-year-old Children and Associations with Family-related Factors

Psychosocial predisposing factors for infantile colic.

Childhood headache at school entry A controlled clinical study

Pain experience of children with headache and their families: A controlled study.

Academic Achievement of Small-for-Gestational-Age Children at Age 10 Years